Heel Pain (Plantar Fasciitis)

Pain felt on the sole of the foot but most commonly at the heel is called Plantar Fasciitis. There may or may not be a heel spur present on the x-ray.

The pain is caused by inflammation of the plantar fascia. The plantar fascia is a thick fibrous band that arises at the heel bone and divides into five bands and is inserted into each of the five toes.

The most common site of injury of the plantar fascia is at its origin at the heel bone. Younger people more commonly experience symptoms in the arch area of the sole of the foot.

These include sharp pain on putting the foot to the ground first thing in the morning and pain following periods of rest or post driving.

Causes of plantar fasciitis

  • Tight calf muscles.
  • A tight plantar fascia.
  • Poor foot mechanics.
  • Flat unsupportive footwear.
  • A sudden increase in weight-bearing activities

This is directed to the cause of the problem and includes the following.

  1. An exercise programme to stretch the posterior calf muscles and the plantar fascia if necessary.
  2. A biomechanical assessment to determine if the patient has abnormal biomechanics that could be causing the problem. Plantar fasciitis is not only associated with flat feet.
  3. If there is poor biomechanics then either a custom orthotic or a prefabricated orthotic may be required.
  4. Shoes that have good heels. Flat pumps or unsupportive shoes may be the cause of the problem. Trainers with good heels that are used by runners are usually very acceptable. This type of footwear will take the pressure off the plantar fascia by lifting the heel.
  5. No barefoot walking, not even a step. Shoes should be left beside the bed at night so straight into them first thing in the morning. Every time you walk in bare feet it is like picking the “scab” and you start the inflammation all over again.
  6. Rest from weight-bearing exercise as much as possible.
  7. Night splints for the very resistant plantar fasciitis.
  8. If all the above fails Injection to the exact site of the origin of the pain by a skilled medical practitioner who injects these conditions regularly.

Successful treatment for plantar fasciitis is slow and requires good patient compliance and observation of the practitioner’s recommendations.

Siobhan Treacy MCSP, MISCP, FSOM
Chartered Physiotherapist
Walkwell Clinic